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ePaper created 2014-12-05, 15:38:45 | version 1.33.01
I 11 opinion _ CBCT in dental office I cone beam4_2014 owner/operators are exposed. Were CBCT studies believed to be of little value or represent minimal risk these leaders in the dental malpractice indus- try would not offer such coverage. Additionally OMNSIC requires the owner/operator to have CBCT images interpreted by a dental or medical radio- logist to minimise risk. _Multispecialty use and recognition Dentistry has nine recognised specialties; four (oral and maxillofacial surgery, endodontics, oral and maxillofacial radiology, and orthodontics) and the American Dental Association have produced literature to address the impact of CBCT on patient care. Of the remaining five specialties, periodontics and prosthodontics could logically be appropriate groups to produce a position paper on CBCT given theirmembersparticipationindentalimplanttreat- mentofpatients.Paediatricdentistrymaysoonpro- vide a position paper once the long-term studies have been done to assess the risk versus benefits analysis with respect to the total overall radiation dose and its effect on the paediatric population. The specialty of dental public health is unlikely to weigh on the matter. ThevalueCBCThasindiagnosisandtreatmentof patients is widespread and recognised by medical disciplines such as plastic and reconstructive sur- gery, ENT, Craniofacial/CLP surgeons, and OMFS trauma surgeons. These medical disciplines recog- nise the high quality three dimensional detail CBCT provides and assists doctors in the treatment planning and diagnosis of their patients. Such widespread and multidisciplinary application of CBCT imaging contributes to CBCT is becoming a new standard of care. _CBCT in the dental culture Many in the dental profession acknowledge the benefit of 3-D imaging to patients and doctors. There is little dispute that CBCT provides superior representation of the anatomy verses 2-D plain films. Quality of product acknowledged, at least four aspects of CBCT must work their way through the dental culture before CBCT becomes A standard of care: cost, availability, legal, and patient expec - tations. Two of these aspects (cost and availability) will more likely than not be determined by the in - visible hand of the market as the Keynesians laws of supply and demand move the dental industry to provide the best possible service at a price patients and insurance companies are willing to pay. The third (legal) will be slowly determined in the court systemsasattorneysandexpertsbegintorelymore on CBCT in support of their clients’ cases. Patient expectations are difficult to accurately ascertain. We know patients expect our practices to be contemporary. Buying the latest and greatest machine for your practice may not be wise if cost exceeds benefits both clinically and financially. As CBCT becomes widely accepted and expected by our patients due to aggressive marketing or clinical relevance, incorporating the technology into one’s practice may not be entirely necessary but prudent as others in the profession who possess the tech- nology appear to be more contemporary and ad- vanced in their patient care. There are many questions yet to be answered definitively regarding CBCT: 1. Whoisresponsible(andliable)forinterpretingthe images? 2. Is an entire field of view interpretation necessary or simply the pertinent structures? 3. Must all images be interpreted by a board certi- fied oral and maxillofacial radiologist or can the ordering doctor interpret the images? 4. What level of training is sufficient to own and operate the machine, as well as, and interpret CBCT images? 5. What cases deserve a CBCT? 6. If the patient refuses a CBCT and the dentist believes a CBCT is necessary for successful case completion, must the dentist complete the case without the CBCT study or can he refuse the case without fear of legal repercussions? Lastly, as mentioned earlier, standard of care is an evolving concept. Darwin stated clearly any organism (or concept in this case) which is subject to the laws of evolution must adapt in response to outside forces in order to survive. The standard of careindentistryisadaptingtoCBCTasforces(legal, financial, clinical, and consumer) act upon the in- dustry to account for the powerful influence CBCT has on treatment planning and diagnosis of pa- tients. While recognising that all that glitters is not gold,CBCTmaysoonrepresentanewgoldstandard by which many cases will be judged._ Lee M.Whitesides, DMD,MMSc 4700 Chamblee Dunwoody Rd.,Ste.400 Dunwoody,GA 30338,USA Drmac5678@gmail.com cone beam_contact CBE0414_06-11_Whitesides 28.11.14 11:55 Seite 6 CBE0414_06-11_Whitesides 28.11.1411:55 Seite 6